FIXED-TIME PERIOD EXTENSION REQUEST FORM

INSTRUCTIONS (Please Read):

===> You may either print out a blank form or fill in the text areas below and print the form with your responses.

PLEASE NOTE: This form is NOT to be used for title update or address correction.

1. Use the boxes below to describe all appurtenant information. (This will be reviewed and may determine the action of the

State Engineer regarding your Fixed-Time Period Extension Request.)

2. Describe briefly in the box provided below why a Fixed-Time period extension is necessary.

3. Generate Form by pressing "Generate Printable Form."

4. Sign the form.

5. If you have additional supporting documentation, please attach.

6. The filing fee for an extension request is $150.

7. Enclose the fee (check or money order made out to "Utah Water Rights") with the extension request and mail or hand

deliver to the Division of Water Rights, 1594 West North Temple, Suite 220, Salt Lake City, UT 84114.

The Adobe reader is required to print the EXTENSION form. It can be acquired at the following link:

Water Right Number:	Blank Form?

1. Number of Additonal Years being requested: 5 10 15 20

2. Describe briefly why a Fixed-Time period extension is necessary. Section 73-3-8 of the Utah Code

Annotated 1953 (as amended), lists the following quidelines on which an extension request might be considered:

1) the essential purpose of the original application has not been satisfied,

2) the need for an extension is not the result of any default or neglect by the applicant, and

3) the water is still available.